Mail-order RX’s hard pill for local pharmacists to swallow

Saturday

With health care costs continuing to rise, employers and employees are finding ways to save money on coverage.

With health care costs continuing to rise, employers and employees are finding ways to save money on coverage.

According to local pharmacists, a common way to reduce costs can seriously harm their businesses.

That practice — insurance companies requiring customers to mail order long-term prescriptions — has hurt many local pharmacies, according to Randy Weaver, owner of Maple City Pharmacy.

“The lion’s share of our business is what are called ‘maintenance’ drugs,” Weaver said, adding the losses have affected his business quite a bit. “It probably depresses my numbers by a good 20 to 30 percent.”

Most companies allow for at least the first refill of a prescription to be purchased at a local pharmacy, and after that, the company may require all future prescriptions to be filled by a mail order company — sometimes owned by the insurance carrier. An example of that is PrimeMail, a common mail-order company, which, according to its Web site, is owned by a coalition of Blue Cross Blue Shield organizations from across the country.

“The nice part is, they let us start you out and then they take the gravy,” Weaver said. “It’s very low profit, but I don’t care as long as I’m allowed to play.”

A handful of local employers, like St. James Mercy Health System, Canisteo-Greenwood Central School District, National Fuel and The Evening Tribune, local pharmacists said, require employees to mail order any long-term prescriptions.

Some of those changes, including National Fuel and The Evening Tribune, occurred within the past few months in an effort to cut rising costs.

According to Bebe Cappadonia, benefits coordinator for St. James Mercy Health System, the company began requiring maintenance drugs to go through the mail around 2004.

"With that plan, any employee can get up to three refills locally," Cappadonia said.

Reviews of the program have been generally positive.

"Some employees just love it," she said, adding employees have noted ordering online as a nice convenience from the program.

Employees also pay co-pays for two months of medication when they order three months worth.

There have been, Cappadonia said, a few complaints.

Most complaints have been focused on delays in processing and employees forgetting they need to switch to the mail order service after three refills.

The hospital has discussed changing back to an optional system previously, but "it hasn't come up recently," Cappadonia said.

Some employers, like the City of Hornell, do not require employees to mail order maintenance drugs, but encourages them to.

“They don’t have to, but it makes sense to,” Hornell Mayor Shawn Hogan said. “A lot of people take advantage of that.”

For long-term prescriptions, like blood pressure or cholesterol medication, having a ready supply on hand proves to be useful for some employees, Hogan said. Another advantage is employees only need to pay one co-pay for a 90-day supply, as opposed to paying for three separate months.

But Hogan, who said he is on maintenance drugs, said he prefers to deal locally for his own needs.

As health insurance costs continue to rise, Hogan said, the city could change to a mail-order only policy, but there may not be any savings at all for the city’s taxpayers.

Another proposed change — making Medicare and Medicaid prescriptions go to mail-order companies — has been thrown around for several years, Weaver said.

“I know there’s been some rumblings (to make it mandatory),” Weaver said. “Some (Medicare) Part D’s have that as an option.”

As the population gets older and Medicare enrollment rises, costs will continue to rise and government officials will try to cut costs in the programs, he added.

According to Weaver, pharmacists have been trying to fight against such requirements for years.

One battle won several years ago was for the business of Hornell City School District employees.

“They used to require mail order,” Weaver said, adding he and other local pharmacists called school officials asking to change the rules.

Even though costs can be in the consumers favor, there are several problems with mail-order prescription services.

Andy Allen, owner of Beaver’s Pharmacy in Canisteo, said the standard turn-around time on a mail-order prescription is two weeks.

“A lot of them (patients) don’t think that far ahead,” he said.

Another problem is the weather, Allen said. He referred to a story told to him by a former maintenance medication customer who found out her medication was sent to the wrong address — leaving the medication out in the cold all day.

“That’s not real good for the medicine,” he said. “Take something like insulin. It has to be refrigerated, but the second you freeze it, it’s worthless.

“This lady, her stuff was out there for 5 to 6 hours,” Allen continued. “That’s not a good thing.”

The same kind of problems can arise when the medication is left out on a hot day, which breaks down the chemicals in the prescriptions and make them less effective.

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